Provider Demographics
NPI:1023172426
Name:MARBLE, BENJAMIN K (DPM)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:K
Last Name:MARBLE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1619 N GREENWOOD ST
Mailing Address - Street 2:#300
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-2657
Mailing Address - Country:US
Mailing Address - Phone:719-543-2476
Mailing Address - Fax:719-543-2479
Practice Address - Street 1:1619 N GREENWOOD ST
Practice Address - Street 2:# 300
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2657
Practice Address - Country:US
Practice Address - Phone:719-543-2476
Practice Address - Fax:719-543-2479
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO665213ES0103X
UT5943612-0501213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO19253044Medicaid
COP00412290OtherRAILROAD MEDICAR
CO808770Medicare UPIN
COC808769Medicare PIN